Monday, May 1, 2017

The cost of saving a life

Today I researched on the internet the cost of the maintenance drug
that I take to help extend the length of my remission. Although I could not
find 2017 prices or the price at which the pharmaceutical company had sold the
drug to the government in prior years, I did find lots of prices for the drug
sold to individuals or non-federal healthcare providers in prior years. A reasonable
estimate is that my monthly maintenance dose costs approximately $15,000.

When that cost is combined with other treatment and healthcare that I have
received because of having cancer, in the eight months since being diagnosed
with cancer my care has cost more than $200,000. Ongoing care in years while I remain
in remission plus additional costs related to forcing the cancer into remission
a second and perhaps third time could easily drive the total cost of treating
my cancer to well over one million dollars.

Few Americans can afford to pay one million dollars to treat a
catastrophic illness.

On the other hand, few Americans would opt to refuse treatment to a
person who suffers from the type of cancer that I have who cannot pay for
treatment when the person can reasonably expect to enjoy several or more years of
healthy, productive life.

The best way forward in dealing with the cost of catastrophic illness
is for the US to implement single payer, universal healthcare. The single payer
would be the federal government. Universal access means that everyone would
have access.

Half of all persons employed in the healthcare industry, which is 20%
of the US Gross Domestic Product, are not healthcare providers but
administrative, etc. A quarter of healthcare costs is attributable to billing
and associated costs. Eliminating private payers would shutter the immensely
profitable private health insurance corporations, but would concurrently generate
tremendous savings in healthcare related costs for the entire nation.

Two examples of a single payer system – with the federal government as
that single payer – already exist in the US, though both systems limit access. The
first is Medicare, available to everyone over 65 and the lowest cost provider
of healthcare. The second is the military healthcare system, available to
active duty and retired military personnel and their families.

Congress should replace the Affordable Care Act (Obamacare) with a
single payer system that provides universal access.

2 comments:

Do you expect that a single payer/universal access health care system would increase keep same, or decrease the total share of GDP allocated to health care services? Would overall administrate costs increase, stay the same, or decrease? How much, if any, of the administrative costs now included would be eliminated, rather than merely shifted from the private sector to the public sector? What is the government administrative cost per beneficiary for Medicare and Medicaid? Is this more or less than the administrative cost per beneficiary of the private health insurance system? If the administrative cost per beneficiary for Medicare/Medicaid is greater, does this imply that s single government payer system would experience a net increase in the administrative cost component, eliminating the anticipated resource saving? If not, how much would be the efficiency gain of shifting resources from administration to direct services provision? The U.S. devotes a larger share of GDP to health care than many other economically advanced countries, but what is the reason for this and how, if at all would the adoption of a single-payer, universal care system affect the causes of the U.S. outcome? How much of the cause of higher GDP proportion allocated to health care is the result of administrative inefficiency; how much is the result of poorer health condition of the U.S. population because of behavioral choices; how much is the result of a greater desire to consume health care services, especially near the end of life? How would a single-payer universal access system constrain utilization to control and ration total resources available for health care? or would it or should it constrain individual choices to consume health care services? There are both ethical and economic issues here that need to be addressed carefully and honestly.

You ask a plethora of good questions. Medicare/Medicaid currently provides the lowest cost option for healthcare in the US, so costs should decrease. Administrative costs for all healthcare averages 25% of spending on healthcare, so both administrative costs and total healthcare spending should decrease. Most importantly, a single payer system would provide universal access. Presumably, behavioral choices in the US are not dramatically different than in developed European countries (there are differences, but I'm guessing that the differences as a whole do not represent a huge difference in health outcomes); substantial differences in outcomes are attributable to how the US funds healthcare and the disproportionately large expenses on people near the end of life on treatments that neither improve their quality or length of life in a way commensurate with the cost. We now ration healthcare based on ability to pay, a very unethical approach that values the well-being of the affluent over all others.